SharecloseShare pageCopy linkAbout sharingimage copyrightEPADenmark has ceased giving the Oxford-AstraZeneca Covid vaccine amid concerns about rare cases of blood clots, the first country to do so entirely.The move is expected to delay the country’s vaccination programme by several weeks.Drug watchdog the European Medicines Agency last week announced a possible link with clots but said the risk of dying of Covid-19 was much greater.Several European countries have previously suspended the jab briefly.Most have now resumed vaccinations with AstraZeneca for older population groups.On Tuesday, the US, Canada and the European Union paused the Johnson & Johnson vaccine for similar reasons.Blood clot is ‘very rare AstraZeneca side effect’What you need to know about vaccine safetyThe EU’s vaccine roll-out has been criticised by the World Health Organization (WHO) for being too slow, and there are concerns this latest delay could throw it into further turmoil. Both vaccines work by a similar method, known as adenoviral vectors.Danish officials said that all 2.4 million doses of the AstraZeneca vaccine would be withdrawn until further notice.”The Danish Health Authority has decided to continue the vaccination against Covid-19 without the vaccine from AstraZeneca,” it said in a statement.However, it said it could not rule out using it again at another time.Is Europe’s Oxford jab decision-making flawed?Is the Oxford AstraZeneca vaccine safe?Almost one million people in Denmark have been vaccinated, with approximately 150,000 of them receiving the AstraZeneca jab.The Pfizer/BioNTech and Moderna vaccines are also in use.Denmark was first country to postpone use of the AstraZeneca vaccine in March. It was followed by numerous other European countries.

People who tended to be sedentary were far more likely to be hospitalized, and to die, from Covid than those who exercised regularly.More exercise means less risk of developing severe Covid, according to a compelling new study of physical activity and coronavirus hospitalizations. The study, which involved almost 50,000 Californians who developed Covid, found that those who had been the most active before falling ill were the least likely to be hospitalized or die as a result of their illness.The data were gathered before Covid vaccines became available and do not suggest that exercise can substitute in any way for immunization. But they do intimate that regular exercise — whether it’s going for a swim, walk, run or bike ride — can substantially lower our chances of becoming seriously ill if we do become infected.Scientists have known for some time that aerobically fit people are less likely to catch colds and other viral infections and recover more quickly than people who are out of shape, in part because exercise can amplify immune responses. Better fitness also heightens antibody responses to vaccines against influenza and other illnesses.But infections with the novel coronavirus are so new that little has been known about whether, and how, physical activity and fitness might affect risks for becoming ill with Covid. A few recent studies, however, have seemed encouraging. In one, which was published in February in The International Journal of Obesity, people who could walk quickly, an accepted gauge of aerobic fitness, developed severe Covid at much lower rates than sluggish walkers, even if the quick striders had obesity, a known risk factor for severe disease. In another study of older adults in Europe, greater grip strength, an indicator of general muscle health, signaled lowered risks for Covid hospitalizations.But those studies looked at indirect measures of people’s aerobic or muscular fitness and not their actual, everyday exercise habits, so they cannot tell us if getting up and moving — or staying still — changes the calculus of Covid risks.So, for the new study, which was published Tuesday in the British Journal of Sports Medicine, researchers and physicians at Kaiser Permanente Southern California, the University of California, San Diego, and other institutions decided to compare information about how often people exercised with whether they wound up hospitalized this past year because of Covid.The Kaiser Permanente health care system was well suited for this investigation, because, since 2009, it has included exercise as a “vital sign” during patient visits. In practice, this means doctors and nurses ask patients how many days each week they exercise, such as by walking briskly, and for how many minutes each time, then add that data to the patient’s medical record.Now, the researchers drew anonymized records for 48,440 adult men and women who used the Kaiser health care system, had their exercise habits checked at least three times in recent years and, in 2020, had been diagnosed with Covid-19. The researchers grouped the men and women by workout routines, with the least active group exercising for 10 minutes or less most weeks; the most active for at least 150 minutes a week; and the somewhat-active group occupying the territory in between.The researchers gathered data, too, about each person’s known risk factors for severe Covid, including their age, smoking habits, weight, and any history of cancer, diabetes, organ transplants, kidney problems and other serious, underlying conditions.Then the researchers crosschecked numbers, with arresting results. People in the least-active group, who almost never exercised, wound up hospitalized because of Covid at twice the rate of people in the most-active group, and were subsequently about two-and-a-half times more likely to die. Even compared to people in the somewhat-active group, they were hospitalized about 20 percent more often and were about 30 percent more likely to die..css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-rqynmc{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.9375rem;line-height:1.25rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-rqynmc{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-rqynmc strong{font-weight:600;}.css-rqynmc em{font-style:italic;}.css-yoay6m{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}@media (min-width:740px){.css-yoay6m{font-size:1.25rem;line-height:1.4375rem;}}.css-1dg6kl4{margin-top:5px;margin-bottom:15px;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:’Collapse’;}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:”;background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}#masthead-bar-one{display:none;}#masthead-bar-one{display:none;}.css-1pd7fgo{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-1pd7fgo{padding:20px;width:100%;}}.css-1pd7fgo:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-1pd7fgo{border:none;padding:20px 0 0;border-top:1px solid #121212;}.css-1pd7fgo[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-1pd7fgo[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-1pd7fgo[data-truncated] .css-5gimkt:after{content:’See more’;}.css-1pd7fgo[data-truncated] .css-6mllg9{opacity:1;}.css-1rh1sk1{margin:0 auto;overflow:hidden;}.css-1rh1sk1 strong{font-weight:700;}.css-1rh1sk1 em{font-style:italic;}.css-1rh1sk1 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#ccd9e3;text-decoration-color:#ccd9e3;}.css-1rh1sk1 a:visited{color:#333;-webkit-text-decoration-color:#ccc;text-decoration-color:#ccc;}.css-1rh1sk1 a:hover{-webkit-text-decoration:none;text-decoration:none;}Of the other common risk factors for severe disease, only advanced age and organ transplants increased the likelihood of hospitalization and mortality from Covid more than being inactive, the scientists found.“Being sedentary was the greatest risk factor” for severe illness, “unless someone was elderly or an organ recipient,” says Dr. Robert Sallis, a family and sports medicine doctor at the Kaiser Permanente Fontana Medical Center, who led the new study. And while “you can’t do anything about those other risks,” he says, “you can exercise.”Of course, this study, because it was observational, does not prove that exercise causes severe Covid risks to drop, but only that people who often exercise also are people with low risks of falling gravely ill. The study also did not delve into whether exercise reduces the risk of becoming infected with coronavirus in the first place.But Dr. Sallis points out that the associations in the study were strong. “I think, based on this data,” he says, “we can tell people that walking briskly for half an hour five times a week should help protect them against severe Covid-19.”A walk — or five — might be especially beneficial for people awaiting their first vaccine, he adds. “I would never suggest that someone who does regular exercise should consider not getting the vaccine. But until they can get it, I think regular exercise is the most important thing they can do to lessen their risk. And doing regular exercise will likely be protective against any new variants, or the next new virus out there.”

Occupations in the industry are increasingly in demand because of an aging population and longer life spans.This article is part of our new series on the Future of Health Care, which examines changes in the medical field.Economists at the Labor Department project that from 2019 to 2029 employment in health care in the United States will grow 15 percent, much faster than the average for all occupations, adding about 2.4 million new jobs during that span.The health care and social assistance sector is expected to add the most new jobs, according to the Bureau of Labor Statistics (B.L.S.), with six of the 10 fastest growing occupations. Spurring the expected growth: care for the aging baby-boom population; longer life spans; and persistent growth in the number of patients with chronic conditions.A recent report by McKinsey & Company similarly expects the greatest growth in labor demand by 2030 among health aides, technicians, wellness occupations and health professionals.As the world adjusts to the coronavirus pandemic, this figure could expand even more, as “demand for workers in the health care and STEM occupations may grow more than before the pandemic, reflecting increased attention to health,” according to the report.Among the fastest-growing health care occupations are physician assistants, nurse practitioners (52 percent job growth rate is predicted from 2019 to 2029; the quickest in the field) and occupational therapy assistants.Researchers at LinkedIn analyzed in-demand jobs pushed by the pandemic’s shock to develop a list of 15 “jobs on the rise.” LinkedIn’s data scientists looked at over 15,000 job titles to uncover the positions that have grown the most, compared with 2019 levels, Andrew Seaman, senior editor for job search and careers at LinkedIn News, said in an interview. “While there was already demand for some of these health care positions, the pandemic intensified that. Since 2019, hiring for health care positions has increased more than 34 percent.”Here are five health care jobs on the rise.Nurse practitionerOverall employment growth of nurse practitioners is projected to top 50 percent from 2019 to 2029. The increase is mainly because of an increased importance on preventive care and demand for health care services from an aging population, according to the Labor Department’s forecast.According to the B.L.S., registered nursing — a related but distinct job, involving separate state licenses and, in some cases, degrees — is listed among the top occupations in terms of job growth from 2019 to 2029, though it is an understaffed field. The B.L.S. projects that 11 million additional nurses are needed to avoid a further shortage.Licensed nurse practitioners, who also must have a registered nursing license, legally are able to prescribe medications and have greater flexibility than registered nurses in diagnosing and treating illnesses. Average salaries also differ: In May 2020, the median annual wage for registered nurses was $75,330, according to the B.L.S.; the median annual wage for nurse practitioners for the same period was $111,680.Nurse practitioners are licensed in all states and the District of Columbia. Certifications include those offered by the American Academy of Nurse Practitioners Certification Board the American Nurses Credentialing Center and the Pediatric Nursing Certification Board.Home health and personal care aideOverall employment of home health and personal care aides is expected to jump 34 percent from 2019 to 2029, according to the Labor Department. The aging baby-boom generation and the growing elderly population are the main reasons for the increase.Home health and personal care aides represent the sixth-fastest growing occupation in the country, according to Labor Department data, but the pay is low at about $12.15 per hour, or $25,280 per year.A home care health aide training program in Queens, N.Y., go over Covid protocols. James Estrin/The New York TimesPresident Biden’s American Jobs Plan to expand home- and community-based care is sparse on details for now, but calls for addressing the industry’s low wages and “makes substantial investments in the infrastructure of our care economy, starting by creating new and better jobs for caregiving workers,” according to the White House’s fact sheet.There’s plenty of need for paid workers at private homes, assisted-living communities, memory-care centers for dementia patients, hospice facilities and nursing homes. While the work, often booked through a home care agency, is rewarding, can be taxing mentally and physically. There are part-time positions in assisted-living facilities or hospices. Short-term training is generally on the job by registered nurses for those working for an agency or in-house facility.There’s typically formal training and a competency test to work for certified home health or hospice agencies that receive reimbursement from Medicare or Medicaid. Requirements vary from state to state. Some employers may require a certified nursing assistant certification and a criminal-background check is standard. CPR training and a driver’s license are helpful, too.Job openings are generally posted by local care facilities. There are a few big caregiving networks for job seekers. CareLinx, based outside of San Francisco, operates like an online matchmaking site for families. The network, which began in 2011, operates nationwide with over 500,000 professional caregivers ranging from certified nurse assistants all the way up to registered nurses and nurse practitioners.Mental health specialistEmployment of substance abuse, behavioral disorder and mental health counselors is likely to grow 25 percent from 2019 to 2029, according to the Labor Department — further boosting current growth.“According to our listing data, jobs in the mental health sector have risen 28 percent since 2019,” said Sara Sutton, chief executive and founder of the job board FlexJobs. “Jobs like behavioral health care manager, risk reduction manager, social worker and case manager fall under this category. Regarding therapy jobs specifically, the board saw a whopping 56 percent increase in 2020. Titles include therapist, psychologist, counselor, and mental health clinician.”LinkedIn data shows nearly 24 percent year-over-year job growth among mental health professionals. Fast-growing positions include behavior therapist, mental health technician and psychotherapist. Most of these roles require an associate degree or higher, and training in areas like play therapy for children, mindfulness and cognitive behavioral therapy.A play therapy set-up at the Nurture House, a counseling center for children in Franklin, Tenn.Kristine Potter for The New York TimesEducational requirements vary but most positions require at least a bachelor’s degree. All states require mental health counselors to be licensed, after completing a period of post degree clinical work under the supervision of a licensed counselor.Wages vary, but according to Payscale.com, a mental health counselor salary ranges from $31,000 to $64,000, annually. The median annual wage for substance abuse, behavioral disorder, and mental health counselors was $47,660 in May 2020, according to the B.L.S.Massage therapistEmployment of massage therapists is projected to grow 21 percent in the next decade, according to the Labor Department. Demand will likely increase as more health care providers understand the benefits of massage and these services become part of treatment plans.This is a job well suited to a home-based business where clients come to a therapist’s in-house studio. A growing specialty is geriatric massage therapy, which is gentle massage for older adults focusing on circulation and relaxation. The core work consists of assessing the client’s medical past and delivering a treatments based on the clients needs.Most states and the District of Columbia regulate massage therapy and require a license or certification after graduating from an accredited training program of 500 or more hours of study and experience, although standards and requirements vary greatly by state or other jurisdiction. A high school diploma or equivalent is usually required for admission to a massage therapy program. The median annual wage for massage therapists was $43,620 in May 2020, according to the B.L.S.A respiratory therapist treating a Covid-19 patient at Sharp Coronado Hospital in Coronado, Calif., in December. Mario Tama/Getty ImagesRespiratory therapistRespiratory therapists treat patients with heart and lung problems such as asthma, chronic bronchitis, emphysema, pneumonia, chronic obstructive pulmonary disease and sleep apnea. They perform diagnostic tests for lung capacity, administer breathing treatments, document patient progress, and confer with physicians and surgeons.Employment of respiratory therapists is forecast to grow 19 percent from 2019 to 2029, according to the B.L.S.Respiratory therapists typically need an associate degree, but some have bachelor’s degrees in respiratory therapy. Respiratory therapists are licensed in all states except Alaska; requirements vary by state. The American Association for Respiratory Care has a job board.Educational courses are offered by colleges and universities, vocational technical institutes and the U.S. military. Completion of a program that’s accredited by the Commission on Accreditation for Respiratory Care may be required to gain a license.Licensure requirements vary by state; for most states they include passing a state or professional certification exam. For specific state requirements, contact the state’s health board. The National Board for Respiratory Care is the main certifying body and the board offers two levels of certification: certified respiratory therapist and registered respiratory therapist. The median annual wage for respiratory therapists was $62,810 in May 2020, according to the B.L.S.

Through open-records laws, Times reporters have acquired data on coronavirus cases that revealed racial inequalities, pinpointed hot spots and uncovered other critical facts.Times Insider explains who we are and what we do, and delivers behind-the-scenes insights into how our journalism comes together.In the early months of the pandemic, pockets of data in some U.S. communities suggested that the coronavirus was infecting and killing Black and Latino people at much higher rates than white people. A team of New York Times reporters tracking outbreaks across the country believed that acquiring granular national data from the Centers for Disease Control and Prevention could confirm this trend. There was just one problem: The federal government didn’t fulfill the reporters’ email request for the data.To overcome that hurdle, Times journalists relied on a decades-old law known as the Freedom of Information Act, which grants the public access to records from almost any federal agency, and on state open-records laws. After the reporters obtained the data, their article, published in July, provided a detailed picture of 640,000 infections detected in nearly 1,000 U.S. counties, the most comprehensive look at coronavirus cases across the country to that point. The report also confirmed that Black and Latino people were indeed bearing the worst of the pandemic.Over the past year, dozens of Times journalists who have been denied case-related data have filed more than 400 FOIA or other open-records requests with government agencies. Through many of these requests, reporters have been able to track cases and deaths and uncover locations of Covid-19 outbreaks.“Having good information, having solid data and really respectfully staying on top of agencies to make sure they are being transparent leads to better accountability, and hopefully better policy,” said Mitch Smith, a National desk correspondent who covers the Midwest and was one of the journalists who reported on the racial inequity story.Filing a FOIA request is, for the most part, as straightforward as writing an email. A reporter can submit a form on the federal FOIA website or a state equivalent, detailing the information sought. FOIA officers will then approve or deny the request, though at times they don’t make a determination for an extended period — weeks, months, sometimes years.Journalists can appeal after a denial or after a deadline to decide or respond to a request has passed, but if the appeal fails or if an agency doesn’t respond, journalists can sue to receive the information, as The Times did to obtain the C.D.C. data underpinning its report on racial inequity. Sometimes, governments try to put up roadblocks in the form of charging exorbitant fees to conduct a records search or requiring a reporter to be a resident of the state where the request is filed, or simply requiring that a form be delivered by hand to a post office. In some of those cases, the courts can again be a recourse.Danielle Ivory, an investigative reporter for The Times, began filing FOIA and open-records requests soon after joining the Covid tracking team a year ago. Early on, she and her colleagues filed requests in almost every state to obtain lists of nursing homes with coronavirus cases and deaths. Ms. Ivory estimated that later, when reporting on coronavirus clusters at universities, they had sent over 200 requests to at least 150 colleges alone for case data, which helped them trace more than 400,000 Covid cases back to the universities in 2020.“A lot of these places didn’t want to disclose the information,” Ms. Ivory said. “Some places told us that they thought it was private. We were asking for aggregate information, so we disagreed with that assessment, and in many cases we were right, because some of them ended up giving it to us.”As prisons and jails began reporting spikes in coronavirus outbreaks last year, open-records requests proved instrumental in tracking the spread of cases. Danya Issawi, a member of the team who worked on that project, said that filing FOIAs to sheriff’s offices and local health departments became almost a daily routine, not only for obtaining numbers of infections and deaths at these facilities but also for detention facility populations and information on testing.“All that data represents real human lives and real human consequences in places that don’t readily share numbers,” Ms. Issawi said. “Every time we file a FOIA and get information back, it feels like you’re bridging a little bit of a gap to someone who might have loved ones or a friend.”Now, as vaccination efforts continue, FOIA requests and other open records applications can keep playing a vital role in requiring governments to be transparent. Times journalists have filed dozens of FOIA requests this year alone, checking for distribution patterns or problem areas.But Ms. Ivory is always optimistic that, as more and more people see the value of this data, it may become easier to obtain. “Honestly, I’m really hopeful,” she said.

People who tended to be sedentary were far more likely to be hospitalized, and to die, from Covid than those who exercised regularly.More exercise means less risk of developing severe Covid, according to a compelling new study of physical activity and coronavirus hospitalizations. The study, which involved almost 50,000 Californians who developed Covid, found that those who had been the most active before falling ill were the least likely to be hospitalized or die as a result of their illness.The data were gathered before Covid vaccines became available and do not suggest that exercise can substitute in any way for immunization. But they do intimate that regular exercise — whether it’s going for a swim, walk, run or bike ride — can substantially lower our chances of becoming seriously ill if we do become infected.Scientists have known for some time that aerobically fit people are less likely to catch colds and other viral infections and recover more quickly than people who are out of shape, in part because exercise can amplify immune responses. Better fitness also heightens antibody responses to vaccines against influenza and other illnesses.But infections with the novel coronavirus are so new that little has been known about whether, and how, physical activity and fitness might affect risks for becoming ill with Covid. A few recent studies, however, have seemed encouraging. In one, which was published in February in The International Journal of Obesity, people who could walk quickly, an accepted gauge of aerobic fitness, developed severe Covid at much lower rates than sluggish walkers, even if the quick striders had obesity, a known risk factor for severe disease. In another study of older adults in Europe, greater grip strength, an indicator of general muscle health, signaled lowered risks for Covid hospitalizations.But those studies looked at indirect measures of people’s aerobic or muscular fitness and not their actual, everyday exercise habits, so they cannot tell us if getting up and moving — or staying still — changes the calculus of Covid risks.So, for the new study, which was published Tuesday in the British Journal of Sports Medicine, researchers and physicians at Kaiser Permanente Southern California, the University of California, San Diego, and other institutions decided to compare information about how often people exercised with whether they wound up hospitalized this past year because of Covid.The Kaiser Permanente health care system was well suited for this investigation, because, since 2009, it has included exercise as a “vital sign” during patient visits. In practice, this means doctors and nurses ask patients how many days each week they exercise, such as by walking briskly, and for how many minutes each time, then add that data to the patient’s medical record.Now, the researchers drew anonymized records for 48,440 adult men and women who used the Kaiser health care system, had their exercise habits checked at least three times in recent years and, in 2020, had been diagnosed with Covid-19. The researchers grouped the men and women by workout routines, with the least active group exercising for 10 minutes or less most weeks; the most active for at least 150 minutes a week; and the somewhat-active group occupying the territory in between.The researchers gathered data, too, about each person’s known risk factors for severe Covid, including their age, smoking habits, weight, and any history of cancer, diabetes, organ transplants, kidney problems and other serious, underlying conditions.Then the researchers crosschecked numbers, with arresting results. People in the least-active group, who almost never exercised, wound up hospitalized because of Covid at twice the rate of people in the most-active group, and were subsequently about two-and-a-half times more likely to die. Even compared to people in the somewhat-active group, they were hospitalized about 20 percent more often and were about 30 percent more likely to die..css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-rqynmc{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.9375rem;line-height:1.25rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-rqynmc{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-rqynmc strong{font-weight:600;}.css-rqynmc em{font-style:italic;}.css-yoay6m{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}@media (min-width:740px){.css-yoay6m{font-size:1.25rem;line-height:1.4375rem;}}.css-1dg6kl4{margin-top:5px;margin-bottom:15px;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:’Collapse’;}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:”;background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}#masthead-bar-one{display:none;}#masthead-bar-one{display:none;}.css-1pd7fgo{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-1pd7fgo{padding:20px;width:100%;}}.css-1pd7fgo:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-1pd7fgo{border:none;padding:20px 0 0;border-top:1px solid #121212;}.css-1pd7fgo[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-1pd7fgo[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-1pd7fgo[data-truncated] .css-5gimkt:after{content:’See more’;}.css-1pd7fgo[data-truncated] .css-6mllg9{opacity:1;}.css-1rh1sk1{margin:0 auto;overflow:hidden;}.css-1rh1sk1 strong{font-weight:700;}.css-1rh1sk1 em{font-style:italic;}.css-1rh1sk1 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#ccd9e3;text-decoration-color:#ccd9e3;}.css-1rh1sk1 a:visited{color:#333;-webkit-text-decoration-color:#ccc;text-decoration-color:#ccc;}.css-1rh1sk1 a:hover{-webkit-text-decoration:none;text-decoration:none;}Of the other common risk factors for severe disease, only advanced age and organ transplants increased the likelihood of hospitalization and mortality from Covid more than being inactive, the scientists found.“Being sedentary was the greatest risk factor” for severe illness, “unless someone was elderly or an organ recipient,” says Dr. Robert Sallis, a family and sports medicine doctor at the Kaiser Permanente Fontana Medical Center, who led the new study. And while “you can’t do anything about those other risks,” he says, “you can exercise.”Of course, this study, because it was observational, does not prove that exercise causes severe Covid risks to drop, but only that people who often exercise also are people with low risks of falling gravely ill. The study also did not delve into whether exercise reduces the risk of becoming infected with coronavirus in the first place.But Dr. Sallis points out that the associations in the study were strong. “I think, based on this data,” he says, “we can tell people that walking briskly for half an hour five times a week should help protect them against severe Covid-19.”A walk — or five — might be especially beneficial for people awaiting their first vaccine, he adds. “I would never suggest that someone who does regular exercise should consider not getting the vaccine. But until they can get it, I think regular exercise is the most important thing they can do to lessen their risk. And doing regular exercise will likely be protective against any new variants, or the next new virus out there.”

It felt like the itch was coming from somehow under her skin. The cause ended up being even deeper.It was dark by the time the 41-year-old woman was able to start the long drive from her father’s apartment in Washington, D.C., to her home in Westchester County, N.Y. She was eager to get back to her husband and three children. Somewhere after she crossed the border into Maryland, the woman suddenly developed a terrible itch all over her body. She’d been a little itchy for the past couple of weeks but attributed that to dry skin from her now-faded summertime tan. This seemed very different: much stronger, much deeper. And absolutely everywhere, all at the same time.The sensation was so intense it was hard for the woman to pay attention to the road. She found herself driving with one hand on the steering wheel and the other working to respond to her skin’s new need. There was no rash — or at least nothing she could feel — just the terrible itch, so deep inside her skin that she felt as if she couldn’t scratch hard enough to really get to it. By the light of the Baltimore Harbor Tunnel she saw that her nails and fingers were dark with blood. That scared her, and she tried to stop scratching, but she couldn’t. It felt as if a million ants were crawling all over her body. Not on her skin, but somehow under it.The woman had gone to Washington to help her elderly father move. His place was a mess. Many of his belongings hadn’t been touched in years. She figured that she was having a reaction to all the dust and dirt and who knows what else she encountered while cleaning. As soon as she got home, she took a long shower; the cool water soothed her excoriated skin. She lathered herself with moisturizer and sank gratefully into her bed. But the reprieve didn’t last, and from that night on she was tormented by an itch that no scratching could satisfy.A Year of Unrelenting AgonyAfter two weeks, she went to an urgent-care center. There didn’t seem to be a rash or bites, the doctor told her, but her skin was so red and scratched up that he might not be able to see if there was an allergic reaction or bites from bedbugs or fleas beneath it all. He started her on a two-week course of prednisone; that should calm your itch, he told her, no matter the cause. She took it faithfully. It didn’t help.She cleaned every inch of her house and hired an exterminator to search for bedbugs. She took her dog and two cats to the vet to have them treated for fleas. She bought new mattresses. None of it helped.She saw a dermatologist, who thought it was eczema and recommended a moisturizer. Useless. She went to her internist, who wondered if this could be a symptom of a disease beyond her skin. He asked her if she had noticed any other symptoms. No, she felt fine — except for this itch. He ordered some blood tests, but the only abnormality found, he told her when he called with the results, was a mild iron-deficiency anemia. That can cause pruritus — the medical term for itch — though not usually this severe. She was prescribed an iron supplement and waited for a relief that never came.An allergist found a reaction to dust mites and a chemical preservative used in some cosmetics and cleaning products called methylisothiazolinone (MIT). The patient bought an air purifier, put allergy covers on her (new) mattresses and pillows and searched labels for any MIT-containing products and replaced them. She took antihistamines. The itch continued.A second dermatologist took biopsies from the skin on her thigh and arm. They were unrevealing. He started her on a steroid cream to treat what he thought might be eczema. It had no effect. When a third dermatologist, recommended by a close friend, also suggested that she had eczema, the patient burst into tears. She’d been suffering for over a year. Was she going to feel like this for the rest of her life? That doctor prescribed gabapentin, which can be used to treat pain and itching caused by injured nerves. The drug helped — she was able to get to sleep at night, when the itch was its worst. And it helped a little during the day. But even so, she was still horribly itchy.A New Round of QuestionsThe patient’s husband started doing some research of his own. He found a couple of specialists he thought might help. One was in London, but another, Dr. Melissa Iammatteo, a specialist in allergy and immunology, was quite close. By the time he made this discovery, though, Covid-19 was rampaging through Westchester. His wife scheduled an appointment for the early summer, crossing her fingers that by then it would be safe for her to see the doctor.It was a bright, cool day when the woman finally met Iammatteo. On exam, the patient’s arms and legs were covered with blotches of inflamed red skin, shiny in places and covered with marks from scratching. The patient repeated the story she’d already told a half dozen times: She felt fine except for this terrible itch that drove her nuts.Iammatteo pressed: Did she really feel fine? Like the patient’s internist the year before, she was worried about problems that went beyond the skin. Iammatteo asked her specific questions, which helped the patient realize that she did not actually feel healthy. Yes, the patient acknowledged, she was tired. Yes, she had recently lost a little weight. And, come to think of it, yes, she did sometimes feel feverish, though, no, she didn’t have night sweats.When dealing with patients who have already had an extensive work-up and seen many providers, it’s important to focus on the less likely causes of a symptom. Iammatteo forced herself to think broadly through all the different types of diseases that can cause itching. Diseases of the kidneys and liver are common causes of pruritus — but repeated testing was normal. Infection with parasites or viruses can cause itching; she would order tests for some of the more common of these, including toxocara, a type of parasite carried by cats and dogs, and for H.I.V. It was also important to check for cancer: Nearly 10 percent of patients with persistent unexplained pruritus are found to have cancer. She would order a chest X-ray to look for enlarged lymph nodes. And she would refer the patient to a cancer specialist just in case she’d missed anything.She reviewed the plan with the patient, who needed to go to the lab and the radiology department before she left the building. Iammatteo would call her with the results, she said; it would probably take a few days.Photo illustration by Ina JangA Flurry of Tests, Scans and BiopsiesThe patient hadn’t been home for long when Iammatteo called. She had some results. It wasn’t an answer, but a clue. The X-ray revealed a mass the size of a softball in her chest. Iammatteo wasn’t sure exactly what it was but had sent the image to the cancer specialist. And she had moved up the patient’s appointment with the specialist to that week. Iammatteo was sure he would be able to tell them exactly what was going on.The next few days were a flurry of blood tests, scans and biopsies. Although this was scary, the patient was eager to finally have an answer — even if it meant she had cancer. And that is what it meant. She had Hodgkin lymphoma, an unusual cancer of a type of white blood cell known as lymphocytes. This cancer usually starts in the chest or neck and spreads through the lymph nodes. H.L. is often diagnosed when patients develop enlarged lymph nodes in the neck or under the arms. This patient never had that. Up to 30 percent of patients with H.L. report having pruritus for months or occasionally years before a diagnosis is made. Why this occurs is not well understood.Treatment for this disease can be tough, but the prognosis is good. The patient would need months of chemotherapy. She was eager to start. “I would have done anything to get rid of this itch,” she told me. The itch subsided significantly after the first round of chemo. After six weeks it was gone completely. And it hasn’t come back.As the patient neared the end of her treatment, she tracked down Iammatteo, who now only sees patients with severe drug allergies, to thank her for helping to beat that all-consuming itch.Lisa Sanders, M.D., is a contributing writer for the magazine. Her latest book is “Diagnosis: Solving the Most Baffling Medical Mysteries.” If you have a solved case to share with Dr. Sanders, write her at Lisa .Sandersmd@gmail.com.

Physical inactivity is linked to more severe COVID-19 infection and a heightened risk of dying from the disease, finds a large US study published online in the British Journal of Sports Medicine.
Patients with COVID-19 who were consistently inactive during the 2 years preceding the pandemic were more likely to be admitted to hospital, to require intensive care, and to die than were patients who had consistently met physical activity guidelines, the findings show.
As a risk factor for severe disease, physical inactivity was surpassed only by advanced age and a history of organ transplant.
Several risk factors for severe COVID-19 infection have been identified, including advanced age, male sex, and certain underlying medical conditions, such as diabetes, obesity, and cardiovascular disease.
But physical inactivity is not one of them, even though it is a well known contributory risk factor for several long term conditions, including those associated with severe COVID-19, point out the researchers.
To explore its potential impact on the severity of the infection, including hospital admission rates, need for intensive care, and death, the researchers compared these outcomes in 48,440 adults with confirmed COVID-19 infection between January and October 2020.

SharecloseShare pageCopy linkAbout sharingimage copyrightGetty ImagesA leading Israeli doctor believes the country may be close to reaching “herd immunity”.This happens when enough of a population has protection against an infection that it stops being able to spread – and even people who don’t themselves have immunity are indirectly protected.For Covid the estimated threshold for herd immunity is at least 65%-70%. But scientists in the UK are more cautious. Dr Sarah Pitt, a virologist at the University of Brighton, urged “extreme caution” in concluding that herd immunity had been reached – something she believes will be difficult even at high vaccination rates. She said it was still too early to tell: “We need to see whether the cases in Israel continue to fall and stay at low levels.” Reaching this level of population immunity is important to protect people who can’t be vaccinated or whose immune system is too weak to produce a good, protective response. In Israel, more than half (5.3 million) its residents have been vaccinated and an additional 830,000 people have tested positive for the virus in the past, which should give them some natural immunity. That works out as roughly 68% of the population who are likely to have antibodies in their blood which can fight off the virus. Prof Eyal Leshem, a director at Israel’s largest hospital, the Sheba Medical Center, said herd immunity was the “only explanation” for the fact that cases continued to fall even as more restrictions were lifted. “There is a continuous decline despite returning to near normalcy,” he said. “This tells us that even if a person is infected, most people they meet walking around won’t be infected by them.” And cases are falling in all age groups including children, even though under-16s are not generally being vaccinated. How does herd immunity work?Experts think that with no restrictions in place, someone infected with the original strain of the virus that causes Covid-19, will infect, on average three to four other people.If it’s three, then, in theory, once two-thirds of the population becomes immune to the virus, an infected person will, on average, only pass it to one other person. That’s enough for the virus to spread, but not enough for it to grow.You’ve eliminated two of those three people from the chain of transmission. It sounds simple on paper. In reality, though, it’s a little more complicated.The vaccines are not 100% effective, and even when they stop people from getting sick they don’t completely block infections in everyone. That means some vaccinated people might still be able to pass on the virus.Not everyone with a past Covid infection has strong or long-lasting natural immunity, and newer variants of the virus are more transmissible.This means we may have to inoculate many more people before we reach that magic threshold. But it’s not all bad news. “I would say that we should not be looking for ‘herd immunity’ alone as a sign that we can lift all public health measures and get back to ‘normal’,” Dr Pitt explained. “Rather we should be looking for consistently low levels of Covid-19 infection”. Is the UK close to herd immunity?The UK is a way off this milestone – if it is ever reached. Only about half the population has Covid antibodies, either from infection or vaccination. But the country is already starting to see the impact of vaccination on hospitalisations and deaths, with the biggest declines seen in the most vaccinated age groups.There have been big falls in infection and illness among younger people too which might suggest the vaccine is blocking some transmission – although lockdown will have had a major effect too. After herd immunity, what’s next?So far, new variants don’t seem to be resistant to the vaccine. But a future variant which does show resistance to the virus, Prof Leshem explained, could mean people have less protection and the country could dip below the herd immunity threshold. This isn’t insurmountable – it could be tackled with tweaks to the vaccine, as already happens with the annual flu jab. It serves as an important reminder, though – even if Israel has reached herd immunity, and if the UK follows, this is not necessarily a permanent state.We can look at what’s happened with measles in recent years. The virus was considered to have been eliminated in the UK, but the World Health Organization revoked this status in 2019 after a “marked increase” in measles cases driven by a fall in the proportion of vaccinated people. Measles is highly contagious – each infected person infects roughly 15 other people – so vaccination coverage needs to be over 90% to prevent outbreaks. Follow Rachel on Twitter

Health departments scrambled to postpone vaccine clinics and rebook patients after the one-dose offering from Johnson & Johnson was sidelined.CHICAGO — The student union had been converted into a vaccination center. The doses had arrived on campus. The first appointments were minutes away. Then, at 7:23 a.m. on Tuesday, news of the pause in Johnson & Johnson vaccinations reached Youngstown State University.“We were ready to go,” said Shannon Tirone, an associate vice president at the university, in eastern Ohio, who instead started calling students to tell them they would not be able to get the vaccine after all.Similar scenes played out across the country as the abrupt halt in the use of the Johnson & Johnson vaccine because of concerns about potential blood clots upended plans to vaccinate some of the country’s hardest-to-reach populations.In California, mobile vaccine clinics in rural areas were canceled. In Chicago, vaccination events for restaurant employees and aviation workers were postponed indefinitely. And at colleges in Ohio, New York and Tennessee, where the one-dose vaccine offered a chance to quickly inoculate students before they left campus for the summer, appointments were called off en masse.“It really fit into this kind of tight deadline we were doing,” Ms. Tirone said of the Johnson & Johnson vaccine. She said she hoped to offer another on-campus clinic in Youngstown with one of the two-dose alternatives, but she worried that students would not be eligible for a second dose until finals week or later.At the White House, Biden administration officials played down the effect of the Johnson & Johnson pause and pledged to help states with the logistics involved in rescheduling patients to receive shots from Pfizer and Moderna, the two other coronavirus vaccine manufacturers authorized by the Food and Drug Administration.Federal health officials said the Johnson & Johnson vaccine could be returned to use in days after a review by the Food and Drug Administration and the Centers for Disease Control and Prevention.“The most important thing is that the supply exists to continue to vaccinate three million Americans a day, and there’s enough supply to actually accelerate that,” Jeffrey D. Zients, the Covid response coordinator at the White House, told reporters on Tuesday.In much of the country, public health officials said they were able to offer other vaccines to people who had been scheduled to receive a Johnson & Johnson shot.The Albany County Health Department in New York said it would provide Pfizer doses for a Johnson & Johnson clinic on Tuesday at a local university. The chief public health officer in Detroit said people who had appointments for a Johnson & Johnson vaccine at a city-run site would be allowed to keep their times and receive a Pfizer or Moderna shot. And officials in New Hampshire, who had planned to use the Johnson & Johnson vaccine on Tuesday at clinics and for homebound patients, said they were working to find Pfizer or Moderna doses to use instead.“This news will not slow down New Hampshire,” Gov. Chris Sununu said in a statement. “While the federal government has directed a brief pause in the J&J vaccine, the state is already working with our partners to ensure that they have an alternative supply of Pfizer or Moderna to help continue their efforts today.”But in some places, there was no immediate alternative. In Aurora, Ill., a mass vaccination clinic planned for Tuesday was called off, leaving 1,000 patients without appointments. In Riverside County, Calif., mobile clinics that had planned to vaccinate about 400 people in less populous areas on Tuesday were canceled. And in rural Jefferson County, in southeast Iowa, a Johnson & Johnson clinic targeting manufacturing workers was scrapped at the last minute.“It was so heartbreaking to me,” said Christine Estle, the county’s public health nurse administrator, who said she and her colleagues had encouraged the roughly 140 people scheduled to attend to make appointments at local pharmacies or hospitals.The Johnson & Johnson vaccine had long been seen as a key to the country’s vaccination effort because it requires only one shot, unlike the two-dose Moderna and Pfizer regimens, and because it can be stored more easily. In cities around the country, public health experts had begun using the vaccine in places where hesitancy about one shot — much less two — is high..css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-rqynmc{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.9375rem;line-height:1.25rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-rqynmc{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-rqynmc strong{font-weight:600;}.css-rqynmc em{font-style:italic;}.css-yoay6m{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}@media (min-width:740px){.css-yoay6m{font-size:1.25rem;line-height:1.4375rem;}}.css-1dg6kl4{margin-top:5px;margin-bottom:15px;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:’Collapse’;}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:”;background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}#masthead-bar-one{display:none;}#masthead-bar-one{display:none;}.css-1pd7fgo{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-1pd7fgo{padding:20px;width:100%;}}.css-1pd7fgo:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-1pd7fgo{border:none;padding:20px 0 0;border-top:1px solid #121212;}.css-1pd7fgo[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-1pd7fgo[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-1pd7fgo[data-truncated] .css-5gimkt:after{content:’See more’;}.css-1pd7fgo[data-truncated] .css-6mllg9{opacity:1;}.css-1rh1sk1{margin:0 auto;overflow:hidden;}.css-1rh1sk1 strong{font-weight:700;}.css-1rh1sk1 em{font-style:italic;}.css-1rh1sk1 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#ccd9e3;text-decoration-color:#ccd9e3;}.css-1rh1sk1 a:visited{color:#333;-webkit-text-decoration-color:#ccc;text-decoration-color:#ccc;}.css-1rh1sk1 a:hover{-webkit-text-decoration:none;text-decoration:none;}“I just want to do everything we can to have those people who signed up for appointments still come for them with Pfizer or Moderna,” said Dr. Allison Arwady, the Chicago public health commissioner, who said she worried that the pause would undermine vaccine confidence and that she had already heard of skeptical patients asking whether the other shots were safe.Dr. Arwady said her department had been using the Johnson & Johnson vaccine to reach people who might otherwise be unlikely to seek one out by offering it at workplaces, churches and even along bus lines.“A lot of our more creative planning has been with J&J,” she said. “People who have a lot of barriers to get vaccinated, a single-dose vaccine can be very good.”In Colorado, state officials had expressed optimism that the Johnson & Johnson vaccine would help reach residents who lived far outside cities like Denver or Boulder. Gov. Jared Polis recently kicked off a program using blue and red buses to carry the one-dose vaccine to rural communities around the state.That effort was suspended as the mobile vaccination clinics were shut down for at least Tuesday and Wednesday. Officials did not say when the buses might begin rolling again, or whether they would eventually switch to distributing the Pfizer or Moderna vaccines.The situation was similarly uncertain in Ithaca, N.Y., where officials at Ithaca College canceled their College Student Vaccination Day.“Although unfortunate that we will be unable to provide our students with Thursday’s planned vaccine opportunity, Ithaca College will continue to work with its local partners to identify future clinic opportunities for the two-dose Pfizer and Moderna vaccine series,” the college said in an email.“Thank you for your understanding,” they added.Mitch Smith reported from Chicago, and Michael D. Shear from Washington. Danielle Ivory contributed reporting from New York.

Wheezing, coughing that doesn’t stop, a pale and sweaty face: clinically, severe asthma attacks look very similar from patient to patient. But biologically, not all severe asthma is the same — and a team of scientists has, for the first time, identified the key difference in people, a finding that has important implications for treatment.
In a paper published today in Cell Reports, a group of scientists led by immunologists and pulmonologists at the University of Pittsburgh, in collaboration with Stanford University, used advanced tools of immunology, molecular biology and unbiased computational and bioinformatic approaches to characterize immune profiles of patients with severe asthma. These findings invite a new appreciation for the complexity of disease mechanisms and can lead to improved treatments.
“We started this study to better understand immune mediators of inflammation in asthma,” said lead author Matthew Camiolo, M.D., Ph.D., clinical instructor of medicine at Pitt. “We found that despite being grouped broadly as ‘clinically severe,’ these asthma patients actually had very different and distinct immune profiles.”
Asthma is a debilitating condition that affects millions of people each year. According to the Centers for Disease Control and Prevention, 25 million Americans, or 1 in 13 people suffer from asthma. And while current standards of treatment — inhaled immunosuppressive corticosteroids, such as beclomethasone and budesonide — are effective in most patients, clinical markers that can help identify those who are likely to be resistant to treatment are lacking.
For patients who do not respond to standard corticosteroid treatment or respond to it poorly, there is no ‘one size fits all’ approach to treat severe disease. Because of that, while severe asthma accounts for 5 to 10 percent of all asthma cases, it consumes 50 percent of associated health care costs, amounting to $28 billion annually.
“Although breakthroughs in asthma therapy have greatly improved our ability to treat patients, many people still continue with disease that greatly diminishes their quality of life,” said co-senior author Sally Wenzel, M.D., director of Pitt’s Asthma and Environmental Lung Health Institute, and chair of Pitt Public Health’s Department of Environmental and Occupational Health.
To characterize immune cells within the airways of severe asthma patients, the researchers, in collaboration with Kari Nadeau, M.D., Ph.D., director of the Sean N Parker Center for Allergy & Asthma Research at Stanford University School of Medicine, used mass cytometry, RNA-sequencing and machine learning, and established a novel algorithm that links immune cells to cellular pathways potentially related to disease pathogenesis.
The research team found that lung aspirates from one group of patients were enriched with T cells polarized to fight infections, while the other group had a much lower level of T cells. At the same time, the second group had an increased number of innate immune cells expressing an inflammatory molecule IL-4 — a cytokine known to be elevated in asthma.
“We have identified two clusters of severe asthma patients with very similar biomarkers but with strikingly distinct immune profiles and associated biological pathways,” said senior author Anuradha Ray, Ph.D., professor of medicine and immunology at Pitt. “These findings identify new targets for therapy, which are distinct in the two subgroups of severe asthma patients who otherwise would be indistinguishable based on biomarker profiles.”
“We believe that the cell types expressing IL-4 in the airways of one of the groups have not been previously identified in humans in any setting,” Ray added.
Researchers are optimistic that these findings will enhance precision medicine approaches to treating severe asthma patients.
“These important findings are the result of a successful team effort among physician-scientists and basic scientists across institutions that has established a new frontier in asthma research,” said Ray. “We hope the new knowledge gained will be used to develop new therapeutics to treat severe asthma patients and also allow improved stratification of patients for better efficacy of existing therapies.”